Disparities in melanoma-specific mortality by race/ethnicity, socioeconomic status, and health care systems.
health care systems
health disparities
integrated health care systems
melanoma
melanoma-specific mortality
racial disparities
sociodemographic inequalities
socioeconomic status
Journal
Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
11
07
2022
revised:
28
09
2022
accepted:
01
10
2022
pubmed:
14
10
2022
medline:
3
3
2023
entrez:
13
10
2022
Statut:
ppublish
Résumé
Despite encouraging trends in survival, sociodemographic inequalities persist among patients with melanoma. We sought to quantify the effect of race/ethnicity, socioeconomic status, and health care systems on melanoma-specific mortality within an insured population of patients. Using a retrospective cohort study, we identified insured adults diagnosed with Stage I to IV melanoma from January 1, 2009, to December 31, 2014, followed through 2017, from the California Cancer Registry. We compared melanoma-specific mortality between insured patients diagnosed within the largest vertically integrated health care system in California, Kaiser Permanente Southern California, and insured patients with other private insurance (OPI). Our cohort included 14,614 adults diagnosed with melanoma. Multivariable analyses demonstrated that race/ethnicity was not associated with survival disparities, while socioeconomic status was a strong predictor of melanoma-specific mortality, particularly for those with OPI. For example, hazard ratios demonstrate that the poorest patients with OPI have a 70% increased risk of dying from their melanoma compared to their wealthiest counterparts, while the poorest patients in Kaiser Permanente Southern California have no increased risk. Our main limitation includes inadequate data for certain racial/ethnic groups, such as Native Americans. Our findings underscore the persistence of socioeconomic disparities within an insured population, specifically among those in non-integrated health care systems.
Sections du résumé
BACKGROUND
Despite encouraging trends in survival, sociodemographic inequalities persist among patients with melanoma.
OBJECTIVE
We sought to quantify the effect of race/ethnicity, socioeconomic status, and health care systems on melanoma-specific mortality within an insured population of patients.
METHODS
Using a retrospective cohort study, we identified insured adults diagnosed with Stage I to IV melanoma from January 1, 2009, to December 31, 2014, followed through 2017, from the California Cancer Registry. We compared melanoma-specific mortality between insured patients diagnosed within the largest vertically integrated health care system in California, Kaiser Permanente Southern California, and insured patients with other private insurance (OPI).
RESULTS
Our cohort included 14,614 adults diagnosed with melanoma. Multivariable analyses demonstrated that race/ethnicity was not associated with survival disparities, while socioeconomic status was a strong predictor of melanoma-specific mortality, particularly for those with OPI. For example, hazard ratios demonstrate that the poorest patients with OPI have a 70% increased risk of dying from their melanoma compared to their wealthiest counterparts, while the poorest patients in Kaiser Permanente Southern California have no increased risk.
LIMITATIONS
Our main limitation includes inadequate data for certain racial/ethnic groups, such as Native Americans.
CONCLUSIONS
Our findings underscore the persistence of socioeconomic disparities within an insured population, specifically among those in non-integrated health care systems.
Identifiants
pubmed: 36228942
pii: S0190-9622(22)02800-6
doi: 10.1016/j.jaad.2022.10.004
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
560-567Informations de copyright
Copyright © 2022 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest None disclosed.